Comparative analysis of models predicting the risks of early poor outcome of deceased-donor liver transplantation: a retrospective single-center study

Abstract

Rationale. The risk of early graft loss determines the specifics and plan of anesthesiological assistance, intensive therapy, and overall the feasibility of liver transplantation. Various prognostic models and criteria have become widespread abroad; however, Russian transplant centers have not yet validated them.Objective. To evaluate the applicability and accuracy of the most common models predicting the risks of early adverse outcomes in liver transplantation from deceased donors.Material and methods. A retrospective single-center study included data on 131 liver transplantations from deceased donors performed between May 2012 and January 2023. For each observation, DRI, SOFT, D-MELD, BAR, MEAF, L-GrAFT, and EASE indices were calculated, and compliance with an early allograft dysfunction criteria was verified. Depending on the possibility of calculating the indicators and their values relative to known cutoff points, the study groups were formed, and 1-, 3-, 6-, and 12-month graft survival rates were calculated. The forecast was compared with the actual outcomes, and sensitivity, specificity, F1-score, and C-index were calculated.Results. When assessing the risk of 1- and 3-month graft loss, models using only preoperative parameters demonstrated relatively low prognostic significance: DRI (F1-score: 0.16; C-index: 0.54), SOFT (F1-score: 0.42; C-index: 0.64), D-MELD (F1-score: 0.30; C-index: 0.58), and BAR (F1-score: 0.23; C-index: 0.57). Postoperative indices of MEAF (F1- score: 0.44; C-index: 0.74) and L-GrAFT (F1-score: 0.32; C-index: 0.65) were applicable in 96%, those of ABC (F1-score: 0.29; C-index: 0.71) in 91%, and EASE (F1-score: 0.26; C-index: 0.80) in 89% of cases. The relative risk of 30-days graft loss in case of EAD was 5.2 (95% CI: 3.4-8.1; p<0.0001), F1-score: 0.64, and C-index: 0.84. Using locally established cutoff values for SOFT (11 points) and L-GrAFT (-0.87) scores increased their prognostic significance: F1-score: 0.46 and 0.63, C-index: 0.69 and 0.87, respectively.Conclusion. The analyzed models can be used to assess the risks of early liver graft loss; however, their prognostic significance is not high. Developing a new model in a multicenter Russian study, as well as searching for new objective methods to assess the state of the donor liver are promising directions for future work.

Keywords

• liver transplantation
• graft survival
• prognostic models
• early allograft dysfunction
• primary non-function graft